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NHS bosses rule out charging patients to visit GP

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Ministers and NHS bosses have ruled out patients having to pay to visit their GP, after a survey showed growing support among family doctors for introducing charges. The fees were conceived as a way to help the NHS cope with rising demand for healthcare at a time of tight budgets and to ease the growing pressure GPs are facing. About half of GPs now back the idea, according to a survey of 440 of them conducted by Pulse magazine, although it was a self-selecting, rather than representative sample. Most of those in favour thought charges should be between £5 and £25 per appointment.

A spokeswoman for NHS England said her organisation would not support the introduction of charges. "It is a key principle that NHS services should be free at the point of use, based on clinical need and not an individual's ability to pay," she said. The Department of Health also signalled its opposition to ending free access to GPs. "We have been absolutely clear that the NHS should be free at the point of use, with access based solely on need. That is why we are delivering a real-terms increase in NHS spending and protecting the NHS budget," a spokeswoman said.

The public needed to help the NHS by trying to avoid getting ill in the first place, she added. "We all need to take greater responsibility for living healthier lifestyles so as to reduce the demands we place on the NHS over the longer term." However, NHS England's own chair, Prof Malcolm Grant, said in April that the government that comes to power after the coalition will have to consider introducing charges for NHS services because of the pressure on public finances. He said he opposed charges, but believed they could be necessary unless the economy recovered.

"It's not my responsibility to introduce new charging systems, but it's something which a future government will wish to reflect [on], unless the economy has picked up sufficiently, because we can anticipate demand for NHS services rising by about 4-5% per annum," Grant told the Financial Times. In Pulse's survey, 51% of the 440 GPs who participated said yes when asked: "Would you support charging a small fee for all GP appointments?" Some 36% were against and 13% did not know. That 51% figure is a big rise on the 34% Pulse found when it posed the same question last September.

Dr Stephen McMinn, a pro-charges GP in Bangor, County Down, told Pulse: "[It] has been shown to work in other countries. There needs to be some pressure to decrease patient demand and expectation." Another backer, Dr Shailendra Bhatt, a GP in Hemel Hempstead in Hertfordshire, said: "People don't value the things they get cheap, worse still if they get them for nothing."

But a Bristol GP, Dr Sheila Pietersen, warned that payments could deter some poor patients who genuinely needed to see a GP from attending and "may hinder the doctor-patient relationship". Dr Chaand Nagpaul, chair of the British Medical Association's GPs' committee, said the doctors' union opposed fees. "Charging patients would have adverse effects. We need to preserve trust between patients and their GPs," Nagpaul said. GPs' leaders have warned that more and more family doctors are facing burnout as a result of rising, and ever more complicated, workloads. Appointments with GPs are forecast to double to 433m by 2035, partly as a result of the ageing population.

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